Clinical Pediatric Emergency Medicine
Volume 9, Issue 3 , Pages 149-159 , September 2008

The Jaundiced Newborn in the Emergency Department: Prevention of Kernicterus

  • Vinod K. Bhutani, MD, FAAP

      Affiliations

    • Stanford University School of Medicine and Lucile Packard Children's Hospital, Stanford, CA
    • Corresponding Author InformationReprint requests and correspondence: Vinod K. Bhutani, MD, Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children's Hospital, 750 Welch Ave #315, Stanford, CA 94304.
    • ,
  • Lois Johnson, MD, FAAP

      Affiliations

    • Pennsylvania Center for Kernicterus, Philadelphia, PA

References 

  1. Johnson L, Brown AK, Bhutani VK. System-based approach to management of neonatal jaundice and prevention of kernicterus. J Pediatr. 2002;93:488–494
  2. American Academy of Pediatrics . Clinical practice guideline: management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics. 2004;114:297–316
  3. Bhutani VK, Johnson LH, Maisels MJ, et al. Kernicterus: epidemiological strategies for its prevention through systems-based approaches. J Perinatol. 2004;24:650–662
  4. Van Praagh R. Diagnosis of kernicterus in the neonatal period. Pediatrics. 1961;28:870–874
  5. Jones MH, Sands R, Hyman CB, et al. Longitudinal study of the incidence of central nervous system damage following erythroblastosis fetalis. Pediatrics. 1954;14:346
  6. Perlstein M. Neurologic sequelae of erythroblastosis fetalis. Am J Dis Child. 1950;79:605–606
  7. Volpe JJ. Bilirubin and brain injury. In:  Volpe JJ editors. Neurology of the Newborn. 4th ed.. Philadelphia, PA: W. B. Saunders Co.; 2001;
  8. Bhutani VK, Johnson L, Keren R. Acute bilirubin encephalopathy… before it is too late. Contemp Pediatr. 2005;54–74
  9. Bhutani VK, Johnson L. Kernicterus: a preventable neonatal brain injury. J Arab Neonatal Forum. 2005;Available at: http://www.fmhs.uaeu.ac.ae/neonatal/iss003/pap03.aspAccessed 8/2/08
  10. Ip S, Chung M and the Subcommittee on Hyperbilirubinemia. An evidence-based review of important issues concerning neonatal hyperbilirubinemia. Pediatrics. 2004;114:e130–e153
  11. Hyperbilirubinemia in the neonate: risk assessment, screening and management, Association of Women's Health, Obstetrics and Neonatal Nurses . Available at: http://www.awhonn.org/awhonn/product.detail.do?productCode=HNPP-CD-2NDIAccessed 8/2/08.
  12. Bhutani VK, Johnson L. Kernicterus in late preterm infants cared for as term healthy infants. Semin Perinatol. 2006;30:89–97
  13. Keren R, Luan X, Friedman S, et al. A comparison of alternative risk-assessment strategies for predicting significant neonatal hyperbilirubinemia in term and near-term infants. Pediatrics. 2008;121:e170–e179
  14. Johnson LH, Bhutani VK. Guidelines for management of the jaundiced term and near-term infant. Clin Perinatol. 1998;25:555–574
  15. Wennberg RP, Ahlfors CE, Bhutani VK, et al. Toward understanding kernicterus: a challenge to improve the management of jaundiced newborns. Pediatrics. 2006;117:474–485
  16. Johnson L, Brown AK, Bhutani V. BIND—a clinical score for bilirubin induced neurologic dysfunction in newborns. Pediatrics. 1999;104:746
  17. Shapiro SM. Definition of the clinical spectrum of kernicterus and bilirubin-induced neurologic dysfunction (BIND). J Perinatol. 2005;25:54–59
  18. Hansen TW. Acute management of extreme neonatal jaundice—the potential benefits of intensified phototherapy and interruption of enterohepatic bilirubin circulation. Acta Paediatr. 1997;86:843–846
  19. Hansen TW. Mechanisms of bilirubin toxicity: clinical implications. Clin Perinatol. 2002;29:765–778
  20. Watchko JF. Kernicterus and the molecular mechanisms of bilirubin-induced CNS injury in newborns. Neuromolecular Med. 2006;8:513–529
  21. Bhutani VK, Johnson LH, Keren R. Diagnosis and management of hyperbilirubinemia in the term neonate: for a safer first week. Pediatr Clin North Am. 2004;51:843–861
  22. Smitherman H, Stark AR, Bhutani VK. Early recognition of neonatal hyperbilirubinemia and its emergent management. Semin Fetal Neonatal Med. 2006;11:214–224
  23. Maisels MJ, McDonagh AF. Phototherapy for neonatal jaundice. N Engl J Med. 2008;358:920–928
  24. Dennery PA, Seidman DS, Stevenson DK. Neonatal hyperbilirubinemia. N Engl J Med. 2001;344:581–590
  25. Sheridan SE. Testimony to the National Summit on Medical Errors and Patient Safety Research, Washington, DC, 11 September 2000. Available at: www.quic.gov/summit/wsheridan.htm(21 March 2003)
  26. Sheridan SE. Parents of infants and children with kernicterus. J Perinatol. 2005;25:227–228
  27. Joint Commission Accrediting Hospital Organizations (JCAHO) . Revised guidance to help prevent kernicterus. Sentinel Event Alert. 2004;31:1–2
  28. Bhutani VK, Donn SM, Johnson LH. Risk management of severe neonatal hyperbilirubinemia: to prevent kernicterus. Clin Perinatol. 2005;32:125–139
  29. Blackmon LR, Fanaroff AA, Raju TN, et al. Research on prevention of bilirubin-induced brain injury and kernicterus: National Institute of Child Health and Human Development conference executive summary. 2003. Pediatrics. 2004;114:229–233
  30. Center for Disease Control and Prevention. Jaundice/Kernicterus. http://www.cdc.gov/ncbddd/dd/kernichome.htm. Accessed 8/2/08.

PII: S1522-8401(08)00049-9

doi: 10.1016/j.cpem.2008.06.004

Clinical Pediatric Emergency Medicine
Volume 9, Issue 3 , Pages 149-159 , September 2008

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